Individual
MRS. KATHLEEN NICOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.E.
Contact information
Practice address
2410 PINE ST, ARKADELPHIA, AR 71923-4335
(870) 245-2210
Mailing address
16 WESTERN HILLS DR, ARKADELPHIA, AR 71923-9137
(870) 245-7714
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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